Quadratic Growth of Out-of-Time-Ordered Correlators in Quantum Kicked Rotor Model.

We investigate both theoretically and numerically the dynamics of out-of-time-ordered correlators (OTOCs) in quantum resonance conditions for a kicked rotor model. We employ various operators to construct OTOCs in order to thoroughly quantify their commutation relation at different times, therefore unveiling the process of quantum scrambling. With the help of quantum resonance condition, we have deduced the exact expressions of quantum states during both forward evolution and time reversal, which enables us to establish the laws governing OTOCs' time dependence. We find interestingly that the OTOCs of different types increase in a quadratic function of time, breaking the freezing of quantum scrambling induced by the dynamical localization under non-resonance condition. The underlying mechanism is discovered, and the possible applications in quantum entanglement are discussed.

Residual current detection method based on improved VMD-BPNN.

To further enhance the residual current detection capability of low-voltage distribution networks, an improved adaptive residual current detection method that combines variational modal decomposition (VMD) and BP neural network (BPNN) is proposed. Firstly, the method employs the envelope entropy as the adaptability function, optimizes the [k, ɑ] combination value of the VMD decomposition using the bacterial foraging-particle swarm algorithm (BFO-PSO), and utilizes the interrelation number R as the classification index with the Least Mean Square Algorithm (LMS) to classify, filter, and extract the effective signal from the decomposed signal. Then, the extracted signals are detected by BPNN, and the training data are utilized to predict the residual current signals. Simulation and experimental data demonstrate that the proposed algorithm exhibits strong robustness and high detection accuracy. With an ambient noise of 10dB, the signal-to-noise ratio is 16.3108dB, the RMSE is 0.4359, and the goodness-of-fit is 0.9627 after processing by the algorithm presented in this paper, which are superior to the Variational Modal Decomposition-Long Short-Term Memory (VMD-LSTM) and Normalized-Least Mean Square (N-LMS) detection methods. The results were also statistically analyzed in conjunction with the Kolmogorov-Smirnov test, which demonstrated significance at the experimental data level, indicating the high accuracy of the algorithms presented in this paper and providing a certain reference for new residual current protection devices for biological body electrocution.

Clinical efficacy of total laparoscopic splenectomy for portal hypertension and its influence on hepatic hemodynamics and liver function.

BACKGROUND: The liver hemodynamic changes caused by portal hypertension (PH) are closely related to various complications such as gastroesophageal varices and portosys-temic shunts, which may lead to adverse clinical outcomes in these patients, so it is of great clinical significance to find treatment strategies with favorable clinical efficacy and low risk of complications. AIM: To study the clinical efficacy of total laparoscopic splenectomy (TLS) for PH and its influence on hepatic hemodynamics and liver function. METHODS: Among the 199 PH patients selected from October 2016 to October 2020, 100 patients [observation group (OG)] were treated with TLS, while the remaining 99 [reference group (RG)] were treated with open splenectomy (OS). We observed and compared the clinical efficacy, operation indexes [operative time (OT) and intraoperative bleeding volume], safety (intraperitoneal hemorrhage, ascitic fluid infection, eating disorders, liver insufficiency, and perioperative death), hepatic hemodynamics (diameter, velocity, and flow volume of the portal vein system), and liver function [serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and serum total bilirubin (TBil)] of the two groups. RESULTS: The OT was significantly longer and intraoperative bleeding volume was significantly lesser in the OG than in the RG. Additionally, the overall response rate, postoperative complications rate, and liver function indexes (ALT, AST, and TBil) did not differ significantly between the OG and RG. The hepatic hemodynamics statistics showed that the pre- and postoperative blood vessel diameters in the two cohorts did not differ statistically. Although the postoperative blood velocity and flow volume reduced significantly when compared with the preoperative values, there were no significant inter-group differences. CONCLUSION: TLS contributes to comparable clinical efficacy, safety, hepatic hemodynamics, and liver function as those of OS in treating PH, with a longer OT but lesser intraoperative blood loss.

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients with Completely Lower Pole Renal Tumors.

(1) Background: For completely lower pole renal tumors, we compared the perioperative outcomes of robotic partial nephrectomy via transperitoneal and retroperitoneal approaches. (2) Methods: Complete lower pole renal tumors were defined as tumors that received 1 point for the "L" element of the R.E.N.A.L. and located at the lower pole of kidney. After confirming consistency in baseline characteristics, oncological and functional benefits were compared. Pentafecta achievement was used to represent the perioperative optimal outcome, followed by multivariate analysis of factors associated with the lack of pentafecta achievement. (3) Results: Among 151 patients identified, 116 (77%) underwent robotic partial nephrectomy via a transperitoneal approach and 35 (23%) via a retroperitoneal approach. Patients undergoing transperitoneal robotic partial nephrectomy experienced more blood loss than those undergoing retroperitoneal robotic partial nephrectomy (50 mL vs. 40 mL, p = 0.015). No significant differences were identified for operative time (120 min vs. 120 min), ischemia time (19 min vs. 20 min), positive surgical margins (0.0% vs. 2.86%), postoperative rate of complication (12.07% vs. 5.71%). No significant differences were identified in pathologic variables, eGFR decline in postoperative 12-month (3.9% vs. 5.4%) functional follow-up. Multivariate cox analysis showed that tumor size (OR: 0.523; 95% CI: 0.371−0.736; p < 0.001) alone was independently correlated to the achievement of pentafecta. (4) Conclusions: For completely lower pole renal tumors, transperitoneal and retroperitoneal robotic partial nephrectomy provide similar outcomes. These two surgical approaches remain feasible options for these cases.

Corrigendum: Transcriptional progressive patterns from mild to severe renal ischemia/reperfusion-induced kidney injury in mice.

[This corrects the article DOI: 10.3389/fgene.2022.874189.].

Transcriptional progressive patterns from mild to severe renal ischemia/reperfusion-induced kidney injury in mice.

The renal ischemia/reperfusion (I/R)-induced acute kidney injury incidence after nephron-sparing surgery for localized renal tumors is 20%, but the biological determinant process of postoperative acute kidney injury remains unclear. Using Gene Expression Omnibus database (GSE192883) and several bioinformatics analyses (discrete time points analysis, gene set enrichment analysis, dynamic network biomarker analysis, etc), combined with the establishment of the I/R model for verification, we identified three progressive patterns involving five core pathways confirmed using gene set enrichment analysis and six key genes (S100a10, Pcna, Abat, Kmo, Acadm, and Adhfe1) verified using quantitative polymerase chain reaction The dynamic network biomarker (DNB) subnetwork composite index value is the highest in the 22-min ischemia group, suggesting the transcriptome expression level fluctuated sharply in this group, which means 22-min ischemia is an critical warning point. This study illustrates the core molecular progressive patterns from mild to severe I/R kidney injury, laying the foundation for precautionary biomarkers and molecular intervention targets for exploration. In addition, the safe renal artery blocking time of nephron-sparing surgery that we currently accept may not be safe anymore.

Concurrent Germline and Somatic Mutations in FLCN and Preliminary Exploration of Its Function: A Case Report.

Birt-Hogg-Dube syndrome is an autosomal dominant condition that arises from germline folliculin (FLCN) mutations. It is characterized by skin fibrofolliculomas, lung cysts, pneumothorax, and renal cancer. Here, we present the case of a 36-year-old woman with asymptomatic, multiple renal tumors and a history of spontaneous pneumothorax. Genetic analysis revealed a hotspot FLCN germline mutation, c.1285dupC (p.H429fs), and a novel somatic mutation, c.470delT (p.F157fs). This information and the results of immunohistochemical analysis of the renal tumors indicated features compatible with a tumor suppressor role of FLCN. Two transcription factors, oncogenic TFEB and TFE3, were shown to be regulated by FLCN inactivation, which results in their nuclear localization. We showed that a deficiency in the tumor suppressor FLCN leads to deregulation of the mammalian target of rapamycin signaling (mTOR) pathway. A potential link between FLCN mutation and ciliary length was also examined. Thus, the mutation identified in our patient provides novel insights into the relationship among FLCN mutations, TFEB/TFE3, mTOR, and cilia. However, an in-depth understanding of the role of folliculin in the molecular pathogenesis of renal cancer requires further study.

GTSE1 promotes tumor growth and metastasis by attenuating of KLF4 expression in clear cell renal cell carcinoma.

Clear cell renal cell carcinoma (ccRCC) is one of the most common malignant tumors and is characterized by a poor prognosis. Although G2- and S -phase expressed-1 (GTSE1) is known to be involved in the progression and metastasis of various cancers, its significance and mechanism in ccRCC remain unknown. In the present study, we found that GTSE1 was overexpressed in ccRCC tissues, especially in metastatic samples. Moreover, high GTSE1 expression was positively correlated with higher pT stage, tumor size, clinical stage, and WHO/ISUP grade and worse prognosis. And GTSE1 expression served as an independent prognostic factor for overall survival (OS). In addition, GTSE1 knockdown inhibited ccRCC cell proliferation, migration, and invasion, and enhanced cell apoptosis in vitro and in vivo. GTSE1 was crucial for epithelial-mesenchymal transition (EMT) in ccRCC. Mechanistically, GTSE1 depletion could upregulate the expression of Krüppel-like factor 4 (KLF4), which acts as a tumor suppressor in ccRCC. Downregulation of KLF4 effectively rescued the inhibitory effect induced by GTSE1 knockdown and reversed the EMT process. Overall, our results revealed that GTSE1 served as an oncogene regulating EMT through KLF4 in ccRCC, and that GTSE1 could also serve as a novel prognostic biomarker and may represent a promising therapeutic target for ccRCC.

T-stage-specific abdominal visceral fat, haematological nutrition indicators and inflammation as prognostic factors in patients with clear renal cell carcinoma.

Clear cell renal carcinoma (ccRCC) is the most common histological type of renal cancer and has the highest mortality. Several studies have been conducted on the relationship between adipose tissue and ccRCC prognosis, however, the results have been inconsistent to date. The current study aimed at establishing a link between abdominal fat composition and short-term prognosis in patients with ccRCC after T-stage stratification. We retrospectively analysed 250 patients with pathologically confirmed ccRCC (173 low T-stage and 77 high T-stage) in our hospital. The computed tomography (CT) images were evaluated using ImageJ. Then, subcutaneous and visceral fat areas (SFA and VFA), total fat areas (TFA) and the relative VFA (rVFA) were measured and computed. Meanwhile, biochemical indices of blood serum were analysed. The results showed that rVFA in low T-stage cohort who had a history of short-term postoperative complications were significantly lower than those who did not. No such association was observed in the high T-stage cohort. Further investigation revealed that the correlations between biochemical indexes and fat area-related variables varied across T-stage groups. As a result, rVFA is a reliable independent predictor of short-term prognosis in patients with low T-stage ccRCC but not in patients with high T-stage ccRCC.

Tunnel Magnetoresistance Sensor with AC Modulation and Impedance Compensation for Ultra-Weak Magnetic Field Measurement.

Tunnel magnetoresistance (TMR) is a kind of magnetic sensor with the advantages of low cost and high sensitivity. For ultra-weak and low-frequency magnetic field measurement, the TMR sensor is affected by the 1/f noise. This paper proposes an AC modulation method with impedance compensation to improve the performance. The DC and AC characteristics of the sensors were measured and are presented here. It was found that both the equivalent resistance and capacitor of the sensors are affected by the external magnetic field. The TMR sensors are connected as a push-pull bridge circuit to measure the magnetic field. To reduce the common-mode noise, two similar bridge circuits form a magnetic gradiometer. Experimental results show that the sensor's sensitivity in the low-frequency range is obviously improved by the modulation and impedance compensation. The signal-to-noise ratio of the sensor at 1 Hz was increased about 25.3 dB by the AC modulation, impedance compensation, and gradiometer measurement setup. In addition, the sensitivity of the sensor was improved from 165.2 to 222.1 mV/V/mT. Ultra-weak magnetic signals, namely magnetocardiography signals of two human bodies, were measured by the sensor in an unshielded environment. It was seen that the R peak of MCG can be clearly visualized from the recorded signal.

Protected quantum coherence by gain and loss in a noisy quantum kicked rotor.

We study the effects of non-Hermiticity on quantum coherence via a noisy quantum kicked rotor (NQKR). The random noise comes from the fluctuations in kick amplitude at each time. The non-Hermitian driving indicates the imaginary kicking potential, representing the environment-induced atom gain and loss. In the absence of gain and loss, the random noise destroys quantum coherence manifesting dynamical localization, which leads to classical diffusion. Interestingly, in the presence of non-Hermitian kicking potential, the occurrence of dynamical localization is highly sensitive to the gain and loss, manifesting the restoration of quantum coherence. Using the inverse participation ratio arguments, we numerically obtain a phase diagram of the classical diffusion and dynamical localization on the parameter plane of noise amplitude and non-Hermitian driving strength. With the help of analysis on the corresponding quasieigenstates, we achieve insight into dynamical localization, and uncover that the origin of the localization is interference between multiple quasi-eigenstates of the quantum kicked rotor. We further propose an experimental scheme to realize the NQKR in a dissipative cold atomic gas, which paves the way for future experimental investigation of an NQKR and its anomalous non-Hermitian properties.

The value of sex-specific abdominal visceral fat as measured via CT as a predictor of clear renal cell carcinoma T stage.

Although much is known about how adipose tissue affects the development of clear cell renal carcinoma (ccRCC), little information is available for the utility of sex-specific abdominal visceral fat composition as a predictor of clear cell renal carcinoma (ccRCC) T stage. We conducted CT-based sex-specific abdominal fat measurements in ccRCC patients to assess whether VFA distribution could predict the ccRCC T stage. In total, 253 patients (182 males and 71 females) from our hospital with pathologically confirmed ccRCC (178 low T-stage and 75 high T-stage) were retrospectively reviewed for the present study. Computed tomography (CT) scans were assessed using ImageJ to differentiate between the visceral and subcutaneous fat areas (VFA and SFA), after which the relative VFA (rVFA) and total fat area (TFA) were computed. The relationships between these fat area-related variables, patient age, sex, and BMI, and ccRCC T stage were then evaluated through univariate and multivariate logistic regression analysis to clarify the association between general or sex-specific abdominal visceral fat and T stage. Following adjustment for age, males with high T stage ccRCC exhibited an increased rVFA as compared to males with low T stage ccRCC, with the same relationship being observed among females. This association between rVFA and high T stage was confirmed through both univariate and multivariate models. As thus, sex-specific visceral fat composition is a reliable independent predictor that can identify both male and female patients with high T stage ccRCC.

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients With Complete Upper Pole Renal Tumors.

OBJECTIVES: We compared the outcomes of transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN) for complete upper pole renal masses (1 point for the "L" component of the RENAL scoring system). MATERIAL AND METHODS: We retrospectively reviewed patients who underwent either TRPN or RRPN from 2013 to 2016. Baseline demographics and perioperative, functional, and oncological results were compared. Multivariable analysis was performed to identify factors related to pentafecta achievement (ischemia time ≤25 min, negative margin, perioperative complication free, glomerular filtration rate (eGFR) preservation >90%, and no chronic kidney disease upstaging). RESULTS: No significant differences between TRPN vs. RRPN were noted for operating time (110 vs. 114 min, p = 0.870), renal artery clamping time (19 vs. 18 min, p = 0.248), rate of positive margins (0.0% vs. 3.3%, p = 0.502), postoperative complication rates (25.0% vs. 13.3%, p = 0.140). TRPN was associated with a more estimated blood loss (50 vs. 40 ml, p = 0.004). There were no significant differences in pathologic variables, rate of eGFR decline for postoperative 12-month (9.0% vs. 7.1%, p = 0.449) functional follow-up. Multivariate analysis identified that only RENAL score (odd ratio: 0.641; 95% confidence interval: 0.455-0.904; p = 0.011) was independently associated with the pentafecta achievement. CONCLUSIONS: For completely upper pole renal masses, both TRPN and RRPN have good and comparable results. Both surgical approaches remain viable options in the treatment of these cases.

Radiomics Nomogram of DCE-MRI for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer.

PURPOSE: This study aimed to establish and validate a radiomics nomogram based on dynamic contrast-enhanced (DCE)-MRI for predicting axillary lymph node (ALN) metastasis in breast cancer. METHOD: This retrospective study included 296 patients with breast cancer who underwent DCE-MRI examinations between July 2017 and June 2018. A total of 396 radiomics features were extracted from primary tumor. In addition, the least absolute shrinkage and selection operator (LASSO) algorithm was used to select the features. Radiomics signature and independent risk factors were incorporated to build a radiomics nomogram model. Calibration and receiver operator characteristic (ROC) curves were used to confirm the performance of the nomogram in the training and validation sets. The clinical usefulness of the nomogram was evaluated by decision curve analysis (DCA). RESULTS: The radiomics signature consisted of three ALN-status-related features, and the nomogram model included the radiomics signature and the MR-reported lymph node (LN) status. The model showed good calibration and discrimination with areas under the ROC curve (AUC) of 0.92 [95% confidence interval (CI), 0.87-0.97] in the training set and 0.90 (95% CI, 0.85-0.95) in the validation set. In the MR-reported LN-negative (cN0) subgroup, the nomogram model also exhibited favorable discriminatory ability (AUC, 0.79; 95% CI, 0.70-0.87). DCA findings indicated that the nomogram model was clinically useful. CONCLUSIONS: The MRI-based radiomics nomogram model could be used to preoperatively predict the ALN metastasis of breast cancer.

Chaotic dynamics of a non-Hermitian kicked particle.

We investigate both the classical and quantum dynamics of a kicked particle withPTsymmetry. In chaotic situation, the mean energy of the real parts of momentum linearly increases with time, and that of the imaginary momentum exponentially increases. There exists a breakdown time for chaotic diffusion, which is obtained both analytically and numerically. The quantum diffusion of this non-Hermitian system follows the classically chaotic diffusion of Hermitian case during the Ehrenfest time, after which it is completely suppressed. Interestingly, the Ehrenfest time decreases with the decrease of effective Planck constant or the increase of the strength of the non-Hermitian kicking potential. The exponential growth of the quantum out-of-time-order correlators (OTOC) during the initially short time interval characterizes the feature of the exponential diffusion of imaginary trajectories. The long time behavior of OTOC reflects the dynamical localization of quantum diffusion. The dynamical behavior of inverse participation ratio can quantify thePTsymmetry breaking, for which the rule of the phase transition points is numerically obtained.

Glucose ligand modififed thermally activated delayed fluorescence targeted nanoprobe for malignant cells imaging diagnosis.

Probes with long lifetime fluorescent emission are highly desirable for time-resolved fluorescence imaging to eliminate the interference from short-lived auto-fluorescence. Aromatic-imide-based thermally activated delayed fluorescence material TADF compound with high external quantum efficiency was encapsulated with Glucose-PEG2000-DSPE amphiphilic copolymer to prepare nanoprobe micelles. Glucose-PEG2000-DSPE TADF (GPDT) Micelles had good biocompatibility, biodegradability, less toxicity, and they could be efficiently transported by over expressed GLUT1 on tumor cell membrane, then efficiently targeted lysosome of HepG2 cells. GPDT Micelles had great clinical application and research development value, and be suitable for the application and popularization in fluorescence imaging technology, especially time-resolved fluorescent imaging in living cells.

Directed momentum current induced by the PT-symmetric driving.

We investigate the directed momentum current in the quantum kicked rotor model with PT-symmetric deriving potential. For the quantum nonresonance case, the values of quasienergy become complex when the strength of the imaginary part of the kicking potential exceeds a threshold value, which demonstrates the appearance of the spontaneous PT symmetry breaking. In the vicinity of the transition point, the momentum current exhibits a staircase growth with time. Each platform of the momentum current corresponds to the mean momentum of some eigenstates of the Floquet operator whose imaginary parts of the quasienergy are significantly large. Above the transition point, the momentum current increases linearly with time. Interestingly, its acceleration rate exhibits a kind of "quantized" increment with the kicking strength. We propose a modified classical acceleration mode of the kicked rotor model to explain such an intriguing phenomenon. Our theoretical prediction is in good agreement with numerical results.

Suppressed Kondo effect and Kosterlitz-Thouless-type phase transition induced by level difference in a triple dot device.

Quantum dot system provides an ideal platform for quantum information processing, within which to demonstrate the quantum states is one of the most important issue for quantum simulation and quantum computation. In this paper, we report a peculiar electron state in a parallel triple dot device where the Ruderman-Kittel-Kasuya-Yosida interaction is invalid when the level differences of the dots sweep into appropriate regime. This extraordinary tendency then results in an antiferromagnetic spin coupling between two of the dots and may lead to zero or full conductance, relying deeply on the relation of the two level spacings. e.g. when the level differences are kept equal, the Kondo effect is totally suppressed although the dots are triply occupied, since in this case a local inter-dot transport loop is found to play an important role in the transmission coefficient. By contrast, when the differences are retained symmetric, the Kondo peak reaches nearly to its unitary limit, owing to that the inter-dot transport process is significantly suppressed. To approach these problems, voltage controllable quantum phase transitions of Kosterlitz-Thouless type and first order are shown, and possible pictures related to the many-body effect and the effective Kondo model are given.

Pretreatment Lymphocyte to Monocyte Ratio is an Independent Prognostic Factor in Metastatic Clear Cell Renal Cell Carcinoma.

BACKGROUND: The prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in metastatic clear cell renal cell carcinoma (ccRCC) is not well-described. The purpose of this study was to assess the prognostic role of pretreatment LMR in surgically treated metastatic ccRCC. PATIENTS AND METHODS: One hundred forty-five patients with metastatic ccRCC who underwent cytoreductive nephrectomy between 2006 and 2013 at our institute were identified. Pretreatment LMR was calculated within 1 week before surgical intervention. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method. Pretreatment LMR, as a continuous variable and as a dichotomized variable at a cutoff of 3.0, were analyzed in univariable and multivariable Cox regression models, respectively. Moreover, the impact of the LMR on the predictive accuracy of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) models was evaluated using the Harrell concordance index (C-index). RESULTS: Decreased LMR was statistically correlated with some clinicopathologic characteristics that are indicative of disease aggressiveness and poor prognosis. As both the continuous and dichotomized variable, decreased pretreatment LMR was demonstrated to be independently associated with poorer PFS (P = .041 and P < .001, respectively) and OS (P = .014 and P < .001, respectively). Further study indicated that the dichotomized LMR could improve the predictive accuracy of the IMDC and MSKCC models. CONCLUSION: Pretreatment LMR appears to be an independent prognostic factor of PFS and OS for patients with metastatic ccRCC after surgery, and it can be utilized to enhance the predictive ability of well-established prognostic models.

Presence of sarcomatoid differentiation as a prognostic indicator for survival in surgically treated metastatic renal cell carcinoma.

PURPOSE: To assess the prognostic significance of sarcomatoid differentiation for surgically treated metastatic renal cell carcinoma (mRCC). METHODS: Patients undergoing cytoreductive nephrectomy for mRCC in our center between 2006 and 2014 were included. All enrolled patients were separated into two groups according to the presence of sarcomatoid differentiation. Clinical and pathological variables were recorded. Student's t test or Chi-square test was applied to compare them. Univariate and multivariate Cox regression were performed to determine independent prognostic factors for oncologic outcomes. RESULTS: Of the 184 patients with mRCC included, 27 (14.7%) patients presented with sarcomatoid differentiation. The presence of sarcomatoid differentiation was associated with higher rates of non-clear cell histology (P = 0.009), higher Fuhrman grade (P < 0.001), higher rates of presenting tumor necrosis (P = 0.005), worse IMDC risk group (P = 0.022), and MSKCC risk group (P = 0.020). Patients with sarcomatoid differentiation showed shorter median progression-free survival and overall survival. Multivariate analysis identified that sarcomatoid differentiation was independently associated with progression-free survival (hazard ratio [HR]: 2.002, 95% CI 1.047-3.828; P = 0.036) and overall survival (HR: 1.922, 95% CI 1.073-3.445; P = 0.028). Sarcomatoid differentiation remained to be independently associated with inferior PFS (HR: 2.097, 95% CI 1.091-4.030; P = 0.026) and OS (HR: 2.245, 95% CI 1.276-3.951; P = 0.005) for clear cell mRCC. CONCLUSION: The presence of sarcomatoid differentiation is independently associated with poor oncologic outcomes for surgically treated mRCC patients. The association remains significant when the subject of study is restricted to clear cell mRCC.